Insurance, Medicare, Medi-Cal
To ensure your bill is processed correctly, please bring your insurance card when you check in. Generally, your insurance company's contact information can be found on the back of your insurance card.
Here are links to several private and government insurance providers. Not all insurance carriers are listed.
Medicare, Medicare Advantage and Senior HMOs
Patients who qualify for Medicare have one of the plans below. Programs do not overlap.
Medicare Part A covers inpatient hospital services.
Medicare Part B covers outpatient care, emergency services and inpatient diagnostics.
If a patient has Medicare supplemental coverage, the hospital will automatically bill the insurer for the deductible or co-payment. A patient should present their most current insurance card for the supplemental insurance at each hospital visit. If a patient does not have supplemental coverage, they will be billed for the deductible or co-payment.
These plans contract with Medicare to provide Part A and B benefits. For information about your coverage, call the number on the back of your insurance card. After the plan has paid its portion of the bill, the patient will be billed for the balance.
Senior HMO’s are provided through the following carriers and are billed in place of Medicare.
- Blue Shield Medicare Advantage
- Secure Horizons (PacifiCare)
- Seniority Plus (HealthNet)
After the Senior HMO has paid its portion of the bill, the patient will receive a bill for the balance due.
If Medicare needs more information to process a claim, you can contact them at 1-800-999-1118.
Advanced Beneficiary Notices
Cottage Health provides Medicare patients advanced beneficiary notices before they receive services not covered by Medicare. This notice advises patients that Medicare will not pay for some treatment or services. The notice is given to help patients decide whether to have the treatment and how to pay for it.
Medi-Cal patients who present a benefits identification card and a health initiative identification card will not be billed for services except in certain situations. Medi-Cal patients will be responsible for hospital bills:
- If the patient asks for and receives services that are not covered by Medi-Cal.
- If the patient fails to notify the provider of their Medi-Cal coverage.
- If the patient has other insurance, as well as Medi-Cal coverage, and does not adhere to the Medi-Cal guidelines.
- If the patient owes a Medi-Cal allowable co-payment.
Some services require prior authorization. The primary care physician is responsible for knowing which services need to be authorized. Services that must be authorized include:
- Care at skilled or intermediate nursing facilities
- Non-emergency hospitalizations
- Some outpatient laboratory and imaging procedures
- Some medications
- Some medical equipment, such as wheelchairs
If a service or medication requires prior authorization, the physician will send a treatment authorization request (TAR) form to the Santa Barbara Health Authority. The physician will be notified when the request has been approved or denied.
Santa Barbara Health Authority: www.cencalhealth.org